Healthcare Provider Details

I. General information

NPI: 1780852566
Provider Name (Legal Business Name): CHINWE UKACHI MADU PHARMD, CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 SW 68TH PKWY STE 200
TIGARD OR
97223-9058
US

IV. Provider business mailing address

2108 N ST # 7584
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 971-352-6971
  • Fax: 971-352-6984
Mailing address:
  • Phone: 562-585-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23320
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA14660
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0017579
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0017579
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-85522
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: